Predictive analysis for myasthenic crisis after transsternal thymectomy in patients with myasthenia gravis
Koinuma, T.; Nunomiya, S.; Wada, M.; Misawa, K.; Tanaka, S.; Koyama, K.
Masui. Japanese Journal of Anesthesiology 61(2): 170-176
2012
ISSN/ISBN: 0021-4892 PMID: 22413440 Document Number: 656536
The risk factors for postoperative myasthenic crisis (MC) in patients with myasthenia gravis (MG) receiving preoperative corticosteroids were unknown. Sixty-three consecutive patients who had undergone a transsternal thymectomy for MG were retrospectively analyzed. Of these, 59 patients (93.7%) received preoperative corticosteroids (prednisolone 1-2 mg x kg(-1)) every-other day. In this study, our definition of postoperative-MC was the need for prolonged postoperative mechanical ventilation for more than 48 hours. Six patients (9.5%) met this criterion. The patient background, and preoperative as well as intraoperative management were evaluated to identify risk factors for postoperative-MC. Student's t-test revealed that the lengths of the operation and anesthesia were significantly longer in the postoperative-MC group compared with the control group (P < 0.05). Fisher's exact test revealed that the existence of preoperative bulbar symptoms and incomplete resection of the thymus gland were also more common in the postoperative-MC group (P < 0.05). A logistic regression analysis revealed that the existence of preoperative bulbar symptoms was the only significant risk factor for postoperative-MC. Based on this study, we concluded that the existence of preoperative bulbar symptoms seems to be a predictor for the development of postoperative-MC in patients with MG undergoing a transsternal thymectomy.
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